Luo Haiyan,Li Shuangjie,Li Bixiang,et al.Diagnostic value of children with liver fibrosis by transient elastography[J].Journal of Clinical Pediatric Surgery,2020,19(06):481-485.[doi:10.3969/j.issn.1671-6353.2020.06.004]
瞬时弹性成像技术对儿童肝纤维化的诊断价值研究
- Title:
- Diagnostic value of children with liver fibrosis by transient elastography
- Keywords:
- Ultrasonography; Liver Cirrhosis/DI; Child
- 分类号:
- R604;R364.3+2;R575.7;R725.7;R445.1
- 摘要:
- 目的 评估肝脏瞬时弹性成像技术对儿童肝纤维化的诊断价值。方法 选择2015年1月1日至2018年12月31日在湖南省儿童医院住院治疗的慢性乙型病毒性肝炎患儿及2016年1月1日至2018年12月31日住院的胆道闭锁患儿共153例进行回顾性研究，收集瞬时弹性成像（transient elastography，TE）技术检测的肝硬度测定值（liver stiffness measurement，LSM）及患儿的临床资料。将患儿按以下分组方案进行分组：肝纤维化组（F≥1）和无肝纤维化组（F=0）；明显肝纤维化组（F≥2）和无明显肝纤维化组（F<2）；进展性肝纤维化组（F≥3）和非进展性肝纤维化组（F<3）；肝硬化组（F=4）和非肝硬化组（F<4）。结果 TE技术诊断肝纤维化的受试者工作特征曲线下面积（Area under the curve，AUC）为0.850，最佳截点值为7.4 kPa，灵敏度和特异度分别为79.86%、77.78%；诊断明显肝纤维化者AUC为0.864，最佳截点值为9.2 kPa，灵敏度和特异度分别为70.43%、84.21%；诊断进展性肝纤维化者AUC为0.840，最佳截点值为11.2 kPa，灵敏度和特异度分别为62.67%、93.59%；诊断肝硬化者AUC为0.894，最佳截点值为13.3 kPa，灵敏度和特异度分别为70.83%、91.47%。结论 TE技术对儿童不同程度肝纤维化均有较好的诊断价值。
- Abstract:
- Objective To evaluate the diagnostic value of applying transient elastography for children with liver fibrosis.Methods Retrospective studies were conducted for 153 hospitalized children of chronic hepatitis B and biliary atresia admitted from January 1,2015 to December 31,2018 and from January 1,2016 to December 31,2018 respectively.The values of liver stiffness measurement (LSM) by transient elastography and their general profiles were collected.They were divided into liver fibrosis group (F≥1) and non-hepatic group (F=0); group with obvious liver fibrosis (F≥2) and group without obvious liver fibrosis (F<2); progressive liver fibrosis group (F≥3) and non-progressive liver fibrosis group (F<3); cirrhotic group (F=4) and non-cirrhotic group (F<4).Results The operating characteristic area under curve (AUC) of receiver with liver fibrosis diagnosed by transient elastography was 0.850,the optimal cut-off value 7.4 kpa and the sensitivity and the specificity 79.86% and 77.78% respectively.The AUC of children with obvious hepatic fibrosis was 0.864,the optimal cut-off value 9.2 kpa and the sensitivity and the specificity 70.43% and 84.21% respectively.The AUC of children with progressive hepatic fibrosis was 0.840,the optimal cut-off value 11.2 kpa and the sensitivity and the specificity 62.67% and 93.59% respectively.The AUC of children with cirrhosis was 0.894,the optimal cut-off value 13.3 kpa and the sensitivity and the specificity 70.83% and 91.47% respectively.Conclusion Transient elastography has an excellent application value in the diagnosis of different degrees of hepatic fibrosis in children.
参考文献/References:
1 Bedossa P,Dargere D,Paradis V.Sampling variability of liver fibrosis in chronic hepatitis C[J].Hepatology,2003,38(6):1449-1457.DOI:10.1016/j.hep.2003.09.022.
2 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1941-1960.DOI:10.3969/j.issn.1001-5256.2015.12.002.Chinese Society of Hepatology & Chinese Society of Infectious Diseases,Chinese Medical Association.Guideline of Prevention and Treatment for Chronic Hepatitis B:a 2015 update[J].J Clin Hepatol,2015,31(12):1941-1960.DOI:10.3969/j.issn.1001-5256.2015.12.002.
3 Qiu J,Yan HP,Cheng NC,et al.The clinical and epidemiological study of children with hand,foot,and mouth disease in Hunan,China from 2013 to 2017[J].Sci Rep,2019,9(1):11662.DOI:10.1038/s41598-019-48259-1.
4 Lee J,Kim MY,Kang SH,et al.The gamma-glutamyl transferase to platelet ratio and the FIB-4 score are noninvasive markers to determine the severity of liver fibrosis in chronic hepatitis B infection[J].Br J Biomed Sci,2018,75(3):128-132.DOI:10.1080/09674845.2018.1459147.
5 Sanai FM,Farah T,Albeladi K,et al.Diminished accuracy of biomarkers of fibrosis in low replicative chronic hepatitis B[J].BMC Gastroenterol,2017,17(1):101.DOI:10.1186/s12876-017-0658-x.
6 Schiavon LL,Narciso-Schiavon JL,Ferraz M,et al.The γ-glutamyl transpeptidase to platelet ratio (GPR) in HBV patients:just adding up[J].Gut,2017,66(6):1169-1170.DOI:10.1136/gutjnl-2016-312658.
7 欧晓娟,王晓明,吴晓宁,等.FibroTouch与FibroScan在慢性乙型肝炎患者肝纤维化评估中的比较[J].中华肝脏病杂志,2015,23(2):103-106.DOI:10.3760/cma.j.issn.1007-3418.2015.02.006.Ou XJ,Wang XM,Wu XN,et al.Comparison of FibroTouch and FibroScan for the assessment of fibrosis in chronic hepatitis B patients[J].Chin J Hepatol,2015,23(2):103-106.DOI:10.3760/cma.j.issn.1007-3418.2015.02.006.
8 Ippolito D,Schiavone V,Talei Franzesi CR,et al.Real-time elastography:noninvasive diagnostic tool in the evaluation of liver stiffness in patients with chronic viral hepatitis,correlation with histological examination[J].Dig Dis,2018,36(4):289-297.DOI:10.1159/000480699.
9 Petzold G,Hofer J,Ellenrieder V,et al.Liver stiffness measured by 2-dimensional shear wave elastography:prospective evaluation of healthy volunteers and patients with liver cirrhosis[J].J Ultrasound Med,2019,38(7):1769-1777.DOI:10.1002/jum.14866.
10 Liu J,Li Y,Yang X,et al.Comparison of two-dimensional shear wave elastography with nine Serum fibrosis indices to assess liver fibrosis in patients with chronic hepatitis B:A prospective cohort study[J].Ultraschall Med,2019,40(2):237-246.DOI:10.1055/a-0796-6584.
11 Orasan OH,Iancu M,Sava M,et al.Non-invasive assessment of liver fibrosis in chronic viral hepatitis[J].Eur J Clin Invest,2015,45(12):1243-1251.DOI:10.1111/eci.12543.
12 郭峰,庄小芳,王晓波,等.三种肝纤维化无创诊断对慢性乙型肝炎进展性肝纤维化(≥ F3)诊断价值评估[J].肝脏,2018,23(3):235-238.DOI:10.3969/j.issn.1008-1704.2018.03.016.Guo F,Zhuang XF,Wang XB,et al.Evaluation of three non-invasive tools of liver fibrosis for the diagnosis of chronic hepatitis B progressive liver fibrosis (≥ F3)[J].Chinese Hepatology,2018,23(3):235-238.DOI:0.3969/j.issn.1008-1704.2018.03.016.
13 Qi X,An M,Wu T,et al.Transient elastography for significant liver fibrosis and cirrhosis in chronic hepatitis B:a meta-analysis[J].Can J Gastroenterol Hepatol,2018,2018:3406789.DOI:10.1155/2018/3406789.
14 沈秋龙,陈亚军,王增萌,等.瞬时弹性成像应用于胆道闭锁肝纤维化评估的研究[J].中华小儿外科杂志,2014,35(4):275-279.DOI:10.3760/cma.j.issn.0253-3006.2014.04.009.Shen QL,Chen YJ,Wang ZM,et al.Assessment of liver fibrosis with transient elastography in biliary atresia[J].Chin J Pediatr Surg,2014,35(4):275-279.DOI:10.3760/cma.j.issn.0253-3006.2014.04.009.
15 Zeng X,Xu C,He D,et al.Performance of several simple,noninvasive models for assessing significant liver fibrosis in patients with chronic hepatitis B[J].Croat Med J,2015,56(3):272-279.DOI:10.3325/cmj.2015.56.272.
16 闫珊玲,郑研,韦馨,等.瞬时弹性成像技术与多参数模型评估慢性肝病肝纤维化程度的临床研究[J].实用医院临床杂志,2017,14(4):157-160.DOI:10.3969/j.issn.1672-6170.2017.04.043.Yan SL,Zheng Y,Wei X,et al.Liver transient elastography FibroTouch and multi-parameters model in the diagnosis of liver fibrosis[J].Practical Journal of Clinical Medicine,2017,14(4):157-160.DOI:10.3969/j.issn.1672-6170.2017.04.043.
17 Lin Z,Liang J,Zhu J,et al.Diverse correlations between fibrosis-related factors and liver stiffness measurement by transient elastography in chronic hepatitis B[J].Eur J Gastroenterol Hepatol,2018,30(2):217-225.DOI:10.1097/MEG.0000000000001023.
18 夏清蓉,段星星,何静波.超声弹性成像在肝纤维化中的应用进展[J].临床小儿外科杂志,2016,15(3):295-298.DOI:10.3969/j.issn.1671-6353.2016.03.025.Xia QR,Duan XX,He JB.Advances in applying ultrasonic elastic imaging for liver fibrosis[J].J Clin Ped Surg,2016,15(3):295-298.DOI:10.3969/j.issn.1671-6353.2016.03.025.
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备注/Memo
收稿日期:2020-03-03。
基金项目:国家自然科学基金（编号：8167969）；省属医院重点临床专科建设（编号：湘卫财务发[2019]4号）
通讯作者:李双杰,Email:Lesjie@vip.sina.com